Provider First Line Business Practice Location Address:
1805 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE #5
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-526-1019
Provider Business Practice Location Address Fax Number:
606-526-1038
Provider Enumeration Date:
08/20/2007